California's recovery raises hopes for restoring health, social service cuts

12/12/2012 12:00 AM

12/12/2012 1:39 PM

People camped out overnight, enduring pain and boredom while waiting hours in line for something they could not otherwise afford.

It was not a Black Friday sale, but a free dental clinic this summer that attracted a record number of toothaches to Cal Expo in Sacramento.

Three years earlier, the state eliminated most adult dental services to help balance the budget.

As California recovers from a deep recession and expects several billion dollars' worth of new voter-approved taxes, Democrats and low-income advocates are clamoring to restore health and social service programs such as adult Denti-Cal.

Senate President Pro Tem Darrell Steinberg, D-Sacramento, specifically mentions the dental program as a priority and sees "pent-up demand" to undo the most severe budget cuts, though he isn't sure if that can happen immediately.

"We are really heartened by the fact (Steinberg) is talking about adult dental," said Vanessa Cajina, a health care lobbyist with the Western Center on Law and Poverty. "It would be a huge, huge benefit for folks looking for jobs to be able to go to employers with a full set of teeth, and to know we're not leaving people without dentures."

The buzzword around Democratic circles these days is "investment." Democrats prefer that term over "spending increases," mindful that Gov. Jerry Brown is wary that his party will use new tax dollars to expand government beyond education.

The Democratic governor sees little room to loosen the spending reins, and early indications suggest he will hold true to that position when he releases his budget in January. State court officials tipped reporters that Brown is proposing to slash their funding by $200 million in his January spending plan.

The nonpartisan Legislative Analyst's Office estimates that California faces a $1.9 billion deficit against a $97.7 billion general fund budget next fiscal year, a small gap relative to recent shortfalls, but a gap nonetheless.

"We've made incredible progress the last couple years to get where we are," said Department of Finance spokesman H.D. Palmer. "The worst thing we can do is throw the gearshift in reverse and unwind the progress we've made."

But several advocates described ways in which they believe Brown and lawmakers may begin restoring programs for the poor. Besides Denti-Cal, Steinberg mentioned domestic violence services and funding for college students.

Rebuilding Medi-Cal

Democrats reluctantly agreed last year to restructure California's welfare-to-work program, known as CalWORKs, by slashing the time limit for benefits from 48 months to 24 months if recipients do not find work.

Assemblywoman Holly Mitchell, D-Los Angeles, said she wants to add funding back to CalWORKs but knows lawmakers have to pick their spots, given how politicians have demonized the program.

"CalWORKs is the darkhorse in the world of public policy," she said. "We who believe in the integrity of the program have got to begin to change the perception. It's designed to keep children from slipping into poverty."

Frank Mecca, who heads the County Welfare Directors Association of California, said it may be difficult to reverse new time limits because Brown saw that change as necessary to improve the program, not just save money.

"That's a different conversation from, 'We just cut dental benefits for no good reason other than we couldn't afford them,' " Mecca said.

If lawmakers provide more money for CalWORKs, it may involve better access to child care or more intensive job training for families during the 24 months they are in the program, Mecca said.

Another idea: Provide employer subsidies to hire CalWORKs recipients as a way to help them find permanent jobs, Mitchell suggested.

In 2009, the state eliminated adult dental services for an estimated 3 million low-income residents, saving $111 million annually.

The California Dental Association has held free clinics before. But Dr. Russ Webb, who heads the group's charity arm CDA Cares, said the elimination of most Denti-Cal services has led to record turnout lately. The wait line at Cal Expo snaked throughout the fairground parking lot. In two days, volunteers completed 10,088 procedures on 2,026 patients.

"That number keeps going up, because there's no other place to turn to get these teeth seen," Webb said.

While Denti-Cal has drawn interest from lawmakers, advocates say the overall Medi-Cal program is ripe for additional funding. In recent budgets, state leaders have slashed rates paid to providers, imposed co-pays, and cut services such as adult dental, podiatry and optometry that the federal government does not require. Medi-Cal serves about 8 million low-income residents.

The state stands to get a federal boost to Medi-Cal from the Affordable Care Act. If California agrees, the federal health care overhaul would expand services to poor adults who previously did not qualify because they did not have children or were not disabled. The Affordable Care Act also increases rates paid to Medi-Cal primary care doctors.

Health care advocates say the federal infusion, new tax dollars and economic recovery should help spur California to begin rebuilding its Medi-Cal program.

"Hopefully we move away from the penny-wise, pound-foolish cuts that we've been making," said Anthony Wright, executive director of Health Access California.

'Masters of our domain'

But it is not clear that Brown will embrace the Medi-Cal expansion with open arms, even though the federal government would fully fund new enrollees from 2014 to 2016. Health care advocates say the governor has sent mixed signals about covering hundreds of thousands of new adults, partly because the state would eventually face increased costs to serve the new population.

Brown's Health and Human Services secretary, Diana Dooley, said last month that new tax revenue won't be enough to begin reversing cuts made during the recession. She said the state would also have to be vigilant to ensure that the Affordable Care Act doesn't leave California with large new costs.

"We are concerned," Dooley said. "We want to design and structure the state program to ensure as much as possible we can be masters of our own domain."

Some cuts are scheduled to expire at the end of June, such as a 3.6 percent cut to In-Home Supportive Services. It is unlikely that lawmakers will extend that reduction, given a more positive budget outlook and the clout of labor unions that represent IHSS workers and helped pass tax-raising Proposition 30.

Mitchell said she hopes the Legislature could begin reversing deep cuts to child care services for low-income families. Since the recession, the state has eliminated one-fifth of subsidized child care slots, cut payments to providers and imposed stricter income requirements.

"There are some really critical services that I think we have an obligation to reinstate," Mitchell said.

Despite the needs, Christopher Hoene, executive director of the California Budget Project, said he doesn't foresee an immediate rush to restore programs in light of the state's lingering $1.9 billion deficit.

"It's hard to have a discussion about restoring cuts when you're still in deficit mode," Hoene said. "There will be discussions about what happens two years from now and three years from now that will likely heat up this year. But it doesn't seem much likely there will be a restoration of funds now."

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